All the ways Trump can still kill Obamacare

It’s not over ’til it’s over.

Capitol Hill police officers David Bailey, left, and Crystal Griner listen as President Donald Trump speaks in the East Room of the White House in Washington, Thursday, July 27, 2017, during a ceremony to recognize the first responders from the June 14 Congressional baseball shooting. CREDIT: AP Photo/Evan Vucci

Activists and Congressional Democrats are celebrating the bill’s failure, which represents a major political setback for the GOP and means former President Barack Obama’s signature achievement lives to see another day.

But be warned: it’s not over ’til it’s over. The fight against the ACA will rage on, as President Donald Trump can and likely will undermine the law from inside the White House in several major ways.

Cutting off payments

The president has the ability to cut off cost-sharing reduction payments, which are reimbursements for insurers for providing discounted out-of-pocket costs to low-income individuals under Obamacare.

The executive branch currently pays about $7 billion a year in CSRs, but that could stop at any time because of an ongoing lawsuit filed by House Republicans during the Obama years that claimed the CSRs were unconstitutional. A judge ruled in favor of the House Republicans, but the Obama administration appealed the decision, and the payments have continued in the meantime.

Trump has repeatedly threatened to pull the payments. “[T]here is no Obamacare, it’s dead,” Trump said in an interview with The Economist in May. “Plus we’re subsidizing it and we don’t have to subsidize it. You know if I ever stop wanting to pay the subsidies, which I will… Anytime I want.”

Fostering uncertainty and discouraging enrollment

Trump can also undermine the ACA simply by discouraging enrollment and fostering uncertainty about the law’s future, moves that threaten to destabilize the insurance markets.

“As I said from the beginning, let ObamaCare implode, then deal,” Trump tweeted early Friday morning.

Trump can and likely will discourage enrollment. In January, the administration canceled a round of federally-sponsored ads encouraging people to sign up for the ACA during the open enrollment period. Discouraging widespread buy-in could mean younger, healthier people who are important for subsidizing older, sicker people don’t sign up for insurance, which would ultimately undermine the whole system.

Not enforcing the individual mandate

One of the central tenants of the ACA is the individual mandate, which says people must have health insurance or pay a penalty — and which the White House has already taken steps to undermine.

Soon after his inauguration, Trump signed an executive order that instructed federal agencies to delay implementing provisions that “impose a fiscal burden on any State, or a cost, fee, tax penalty, or regulatory burden.” The executive order also instructed agencies to encourage a “free and open market” in health care services.

Some Republicans have floated allowing people to use their government subsidies to purchase private plans (though Democrats say this could encourage more insurers to drop out of the markets), while Claire McCaskill (D-MO) has proposed allowing people in counties without an insurer to purchase a plan on the D.C. exchange.

In any case, the legislators need to take steps to stabilize the market or the very people the law is intended to be help will be strapped with increasingly expensive premiums or no coverage at all.